Glass Half Empty for Binge-Drinking Women

LONDON, Ontario, Jan. 4 -- Binge drinking appears linked to depression, particularly among women, according to a large survey.

Among women who typically consumed seven or more standard alcoholic beverages on an occasion, 24.5% met diagnostic criteria for major depression compared with 8.2% among women who usually consumed only one drink, said Kathryn Graham, Ph.D., of the Center for Addiction and Mental Health here, and colleagues.

The association was weaker for men and for depressed feelings rather than major clinical depression, which may explain inconsistent findings in previous studies, the authors said in the January issue of Alcoholism: Clinical & Experimental Research.

The researchers surveyed 6,009 men and 8,054 women, ages 18 to 76, by computer-assisted telephone interviews in all 10 Canadian provinces to determine four measures of alcohol consumption (frequency, usual and maximum quantity per occasion, volume, and heavy episodic drinking) during the prior week and the prior year.

Respondents were also questioned using two measures of depressive symptoms. The WHO's Composite International Diagnostic Interview (CIDI) measured DSM-IV major depression diagnostic criteria during the prior year. The Center for Epidemiological Studies Depression Scale (CES-D) assessed feelings of depression during the prior week.

For the overall relationship between depression and alcohol intake, Dr. Graham and colleagues reported:

• No variation overall by gender (P=0.191), though mean correlations were higher for women than for men (0.13 versus 0.10),
• No variation by type of depression measure (P=0.339), with mean correlations of 0.11 for depressed feeling and 0.12 for diagnostic criteria,
• Significant variation by type of alcohol measure (P<0.001),
• A strong relationship for heavy episodic drinking (five or more drinks per day, mean correlation = 0.18) and high quantity per occasion (0.12).

Dr. Graham and colleagues said that these results show that the main factor linking depression to alcohol consumption is binge drinking.

"For alcohol consumption, the results are clear: the main factor linking depression with alcohol consumption is consuming larger amounts per occasion," they wrote.

For binge drinking, the relationship with depression was strongest among women. The correlation size findings were:

• A stronger correlation between meeting CIDI major depression criteria and drinking more than five drinks on any day in the prior week among women than men (0.20 versus 0.14).
• A smaller correlation but still stronger among women for the CES-D depressed feeling and consuming more than five drinks any day in the prior week (0.18 versus 0.16).
• The strongest correlation between meeting CIDI major depression criteria and drinking more than eight drinks on any day in the prior week among women than men (0.29 versus 0.12).
• A smaller correlation but still stronger among women for the CES-D and a binge of eight or more drinks in prior week (0.20 versus 0.16).

There was a small but positive relationship between volume of drinking and depression, but more frequent drinking was either unrelated to depression or linked to lower depression likelihood.

The investigators said these results show that "the overall relationship between depression and alcohol consumption is stronger for women than for men only when depression is measured as meeting a clinical diagnosis of major depression and not when measured as recent depressed affect."

There was no difference in the correlations for CES-D in past-week consumption (r=0.10) compared with prior year consumption (r=0.12), which was similar for CIDI measures.

They said this finding "indicates little support for interpretation of the alcohol-depression relationship being based on direct links between drinking and depression such as depression being an after effect of drinking too much or drinking being used to cope with depressed affect."

"The findings, overall, are more consistent with the explanation that clinical depression is a precursor for alcohol abuse, especially among women," they added.

The authors pointed out a limitation of the study. "These cross-sectional data do not provide information about temporal ordering or causation, and cannot eliminate the possibility that the link between alcohol consumption and depression is due to a third factor causing both," they wrote.

They concluded that future studies looking at depression and alcohol intake should take into account gender and be cautious about which measure of depression is used.

"Clearly, how depression and alcohol consumption are measured does affect the magnitude of the relationship between them," Dr. Graham and colleagues wrote.